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Balancing Patient Care and Self-Care: The Burnout Potential

Healthcare providers are dedicated people who tend to focus on their patients and work, often to the detriment of their own well-being. Especially now, with the heightened challenges and pressures of adjusted practice procedures, personal safety, and high-quality patient care under strained conditions, practitioners are encouraged to reflect on their own personal health-related needs in order to protect their valuable coping and caregiving abilities.1,2

In this video, Tricia O’Brien, MD, IFMCPshares her views for patient and clinician self-care. Dr. O’Brien provides an evidence-based, holistic-minded, person-centered approach to medicine in her private practice and is active in public health advocacy and non-toxic living.

Burnout: Statistics and Support

Burnout is a recognized syndrome characterized by physical and emotional exhaustion due to chronic workplace stress.3 In addition, burnout can include feelings of detachment from work responsibilities, feelings of ineffectiveness, a loss of meaning at work, and reduced personal accomplishment.4,5 In a 2020 Medscape National Physician Burnout & Suicide Report, 42% of the 15,000 responding physicians in over 29 specialties said they felt burnt out (37% of men, 48% of women), and 15-18% reported depression.4 Two top factors contributing to burnout were too many bureaucratic tasks and long hours at work. The top three coping mechanisms were isolating themselves from others, exercising, and talking with friends or family members.4 On an encouraging note, at the time of reporting, the overall 42% burnout response was a decrease from the 46% indicated five years ago.4

Physician burnout is an important issue that has been investigated and monitored frequently in the past, and currently, the potential for burnout is highly visible and concerning due to the extended strain on healthcare professionals during the ongoing COVID-19 pandemic.

Contributing Factors and Consequences

Scientific reviews and yearly studies highlight not only statistics of physician burnout and gaps in knowledge about the situation, but they also attempt to identify the root causes, contributing factors, and impact of burnout in the healthcare community. Recent reporting indicates a need to support the resilience of individual physicians as well as organizations to address problems and systemic challenges within the healthcare culture and medical industry that may contribute to burnout.4,6

Recent literature suggests that sleep disruption, sleep deprivation, and circadian misalignment may contribute to physician burnout.7 In addition, loss of social connectedness within the healthcare community is highlighted as a potential factor, with intervention and support on an institutional level suggested to enhance overall community and well-being.8

Consequences of burnout, compassion fatigue, and distress may range from personal crisis to suboptimal patient care practices. A 2020 cross-sectional observation study suggested that physician burnout may negatively affect patients’ experience of care.9 In the study, 244 physicians rated their level of burnout on a five-point scale, and these results were analyzed with responses from over 30,000 experience-related surveys completed by patients who had seen those physicians.9 Results indicated that a one-level increase in burnout was associated with a 0.43 decrease in an adjusted patient-provider communication experience score.9

Resources and Support: From Meditation to PPE

How do clinicians care for themselves? What are the resources for supporting work-life balance, essential self-care, and perseverance during times of sustained stress? Just as with patients, no single answer will work for everyone. Effective strategies for personal self-care include prioritizing close relationships and maintaining a healthy lifestyle by ensuring adequate sleep, regular exercise, fostering hobbies, practicing mindfulness and meditation, and pursuing spiritual development.10 Recent studies have suggested positive impacts from these self-care approaches:

  • A 2020 nonrandomized pilot study of 34 physicians who had reported having anxiety suggested that the use of an app-based mindfulness program may reduce anxiety associated with burnout by as much as 48% within the first month.11
  • Further, a 2020 randomized clinical trial pilot of 88 physicians found that participants who received only six sessions of professional coaching had a significant reduction in emotional exhaustion and overall burnout and had improved resilience and quality of life.12

During this time of heightened stress and potentially critical conditions experienced by many healthcare professionals, self-care tools are especially important for resilience and coping endurance.1 The American Medical Association (AMA) has updated its suggestions for taking care of caregivers, including institutional policy review, personal protective equipment (PPE) recommendations, and emotional and mental well-being resources.13 The AMA website even offers a free meditation and sleep app for practitioners due to the potential positive impacts of adequate rest and mindfulness practices.13

Conclusion

Large patient volumes, emergency situations, and other life factors may be outside of a clinician’s control; however, implementing personal self-care practices for the protection and maintenance of valuable coping and caregiving abilities is essential for continuing the delivery of quality patient care and ultimately improving patient outcomes. Functional Medicine clinicians continue to improve the quality of life for many patients. As one example, a recent cohort study of over 7,000 patients found that those under Functional Medicine care self-reported significantly greater improvements in health-related outcomes at six months as compared to patients receiving care at a family health center. And at 12 months, those improvements were sustained.14

Lifestyle factors, the fundamental components of Functional Medicine, are key factors of health for both patients and clinicians. Indeed, one of the core lessons in the practice of Functional Medicine is to care for yourself while also caring for your patients. In sum, when personal satisfaction is increased, so too is professional satisfaction. Not only will your patients experience better care, you will feel more satisfaction with your practice and may be less likely to experience burnout.

Find out more about prioritizing clinician self-care at IFM’s Applying Functional Medicine in Clinical Practice (AFMCP) and network with other clinicians focused on promoting health, modeling lifestyle change, and working toward a healthier population of patients and clinicians.
Learn More About Functional Medicine

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References

  1. Bansal P, Bingemann TA, Greenhawt M, et al. Clinician wellness during the COVID-19 pandemic: extraordinary times and unusual challenges for the allergist/immulonogist. J Allergy Clin Immunol Pract. Published online April 4, 2020. doi:10.1016/j.jaip.2020.04.001
  2. Shanafelt T, Ripp J, Trockel M. Understanding and addressing sources of anxiety among health care professionals during COVID-19 pandemic. JAMA. Published online April 7, 2020. doi:10.1001/jama.2020.5893
  3. Burn-out an “occupational phenomenon”: international classification of diseases. World Health Organization. Published May 28, 2019. Accessed April 13, 2020. https://www.who.int/mental_health/evidence/burn-out/en/
  4. Kane L. Medscape national physician burnout & suicide report 2020: the generational divide. Medscape. Published January 15, 2020. Accessed April 13, 2020. https://www.medscape.com/slideshow/2020-lifestyle-burnout-6012460
  5. Grimes PE. Physician burnout or joy: rediscovering the rewards of a life in medicine. Int J Womens Dermatol. 2019;6(1):34-36. doi:10.1016/j.ijwd.2019.12.001
  6. Carrieri D, Pearson M, Mattick K, et al. Interventions to minimize doctors’ mental ill-health and its impacts on the workforce and patient care: the Care Under Pressure realist review. Health Serv Deliv Res. 2020;8(19). doi:10.3310/hsdr08190
  7. Kancherla BS, Upender R, Collen JF, et al. Sleep, fatigue and burnout among physicians: an American Academy of Sleep Medicine position statement. J Clin Sleep Med. Published online February 28, 2020. doi:10.5664/jcsm.8408
  8. Southwick SM, Southwick FS. The loss of social connectedness as a major contributor to physician burnout: applying organizational and teamwork principles for prevention and recovery. JAMA Psychiatry. Published online February 19, 2020. doi:10.1001/jamapsychiatry.2019.4800
  9. Chung S, Dillon EC, Meehan AE, Nordgren R, Frosch DL. The relationship between primary care physician burnout and patient-reported care experiences: a cross-sectional study. J Gen Intern Med. Published online March 23, 2020. doi:10.1007/s11606-020-05770-w
  10. Sanchez-Reilly S, Morrison LJ, Carey E, et al. Caring for oneself to care for others: physicians and their self-care. J Support Oncol. 2013;11(2):75-81. doi:10.12788/j.suponc.0003
  11. Roy A, Druker S, Hoge EA, Brewer JA. Physician anxiety and burnout: symptom correlates and a prospective pilot study of app-delivered mindfulness training. JMIR Mhealth Uhealth. 2020;8(4):e15608. doi:10.2196/15608
  12. Dyrbye LN, Shanafelt TD, Gill PR, Satele DV, West CP. Effect of a professional coaching intervention on the well-being and distress of physicians: a pilot randomized clinical trial. JAMA Intern Med. 2019;179(10):1406-1414. doi:10.1001/jamainternmed.2019.2425
  13. Caring for our caregivers during COVID-19. American Medical Association. Updated April 15, 2020. Accessed April 22, 2020. https://www.ama-assn.org/delivering-care/public-health/caring-our-caregivers-during-covid-19
  14. Beidelschies M, Alejandro-Rodriguez M, Ji X, Lapin B, Hanaway P, Rothberg MB. Association of the functional medicine model of care with patient-reported health-related quality-of-life outcomes. JAMA Netw Open. 2019;2(10):e1914017. doi:10.1001/jamanetworkopen.2019.14017

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